Candesartan

Generic name:

Candesartan

Drug class:

Angiotensin II receptor blocker (ARB)

Dosage form:

• Tablets: 4 mg, 8 mg, 16 mg, 32 mg

Route of administration:

Oral

Dose:

• Hypertension: Initial 8 mg once daily, titrate to 16 mg once daily; max 32 mg once daily
• Heart failure: Initial 4 mg once daily, titrate up to 32 mg once daily as tolerated
• Renal protection in type 2 diabetes with proteinuria: 16 mg once daily; adjust per response
• Special populations (elderly, renal impairment): start at 4 mg once daily; adjust gradually

Mechanism of action:

Candesartan selectively blocks angiotensin II type 1 (AT₁) receptors, inhibiting vasoconstriction and aldosterone secretion, leading to vasodilation, reduced sodium retention, and lowered blood pressure.

Drug usage cases:

• Essential hypertension
• Heart failure (NYHA class II–IV) as adjunct to standard therapy
• Renal protection in type 2 diabetes with proteinuria
• Off-label: migraine prophylaxis, prevention of atrial fibrillation recurrence

Drug contraindications:

• Hypersensitivity to candesartan or excipients
• Second- and third-trimester pregnancy
• Severe hepatic impairment or biliary obstruction
• Bilateral renal artery stenosis or stenosis to single functional kidney
• Concomitant aliskiren use in patients with diabetes

Side effects:

• Dizziness
• Hypotension, orthostatic hypotension
• Hyperkalaemia
• Renal impairment
• Fatigue
• Headache
• Upper respiratory tract infection
• Back pain
• Diarrhea
• Muscle cramps
• Angioedema (rare)
• Rash

Warnings:

• Fetal toxicity: discontinue if pregnancy detected
• Monitor renal function and serum potassium
• Risk of symptomatic hypotension in volume-depleted patients
• Use caution in patients with bilateral renal artery stenosis
• Avoid concomitant potassium-sparing diuretics or potassium supplements
• May cause acute renal failure in susceptible individuals
• Use with other RAAS inhibitors increases risk of hypotension, hyperkalaemia, and renal impairment
• Adjust dose in elderly and those with hepatic impairment

Use during pregnancy or breastfeeding:

Use in the second and third trimesters is contraindicated due to risk of fetal injury, neonatal hypotension, renal impairment, and death. If pregnancy is detected, discontinue promptly. Candesartan is excreted in breast milk; avoid use during breastfeeding or discontinue nursing.